Provider Demographics
NPI:1356492714
Name:GRINNELL-NOAK, KATHARINE M (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:M
Last Name:GRINNELL-NOAK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:M
Other - Last Name:GRINNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2907 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1175
Mailing Address - Country:US
Mailing Address - Phone:630-586-0900
Mailing Address - Fax:630-586-9990
Practice Address - Street 1:2907 BUTTERFIELD RD
Practice Address - Street 2:SUITE 240
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1175
Practice Address - Country:US
Practice Address - Phone:630-586-0900
Practice Address - Fax:630-586-9990
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical